You.have to be getting some hefty tax credits, love that term for other people's money but it's there so it's smart to use it tax credits for me as single with no dependents is no where near that.
Best option to get good medical insurance - I'm not an O/O
- Thread starter Rhonda
- Start date
You.have to be getting some hefty tax credits, love that term for other people's money but it's there so it's smart to use it tax credits for me as single with no dependents is no where near that.
You have other income, right ?
Every business benefit costs somebody else money, this is just one of them. And it's the way group health insurance has always worked. Now, the individual shopper is part of a much larger group. I will not be made to feel badly about using it. I've paid massive taxes most of my life, now I'm getting a small advantage. For others, it may be the reverse. Such is life...
Even with no discount, the policy is $340.90/mo. True, the OOP goes to $2600.00 but that's still quite good on today's health insurance world.
Every business benefit costs somebody else money, this is just one of them. And it's the way group health insurance has always worked. Now, the individual shopper is part of a much larger group. I will not be made to feel badly about using it. I've paid massive taxes most of my life, now I'm getting a small advantage. For others, it may be the reverse. Such is life...
Even with no discount, the policy is $340.90/mo. True, the OOP goes to $2600.00 but that's still quite good on today's health insurance world.
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Individual, thru the Marketplace.
For people who want to understand the policy, numbers like these are meaningless without the rest of the story. Can you share privately with us the contract, or can you direct us to an online location or an agent who can fully explain this product?
Here:
Highmark Inc. Shared Cost Blue PPO 2650 a Community Blue Flex Plan
PPO Silver Reduced costs National provider network ENROLL
Monthly premium
$67.90/mo.
was $340.90
Deductible
$100
Out-of-pocket maximum
$500
Copayments / Coinsurance
$5 Primary doctor
$10 Specialist doctor
$8 Generic drugs
Dental
Dental: Child only
More information
Plan brochure
Summary of Benefits
Provider directory
Costs for medical care Collapse -
Primary care doctor visit $5 In-Network Tier 1; $10 In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Specialist visit $10 In-Network Tier 1; $20 In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
X-rays and diagnostic imaging $5 In-Network Tier 1; $10 In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Laboratory and outpatient professional services $5 In-Network Tier 1; $10 In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Hearing aids Not Covered
Routine eye exam for adults No Charge In-Network Tier 1; No Charge In-Network Tier 2; Not Covered Out-of-Network; 1 Exam(s) per 2 Years
Routine eye exam for children No Charge In-Network Tier 1; No Charge In-Network Tier 2; Not Covered Out-of-Network; 1 Visit(s) per Year
Eyeglasses for children No Charge In-Network Tier 1; No Charge In-Network Tier 2; Not Covered Out-of-Network; 1 Item(s) per Year
Health Savings Account eligible plan No
Prescription drug coverage Collapse -
Generic drugs $8 In-Network Tier 1; $8 In-Network Tier 2; Not Covered Out-of-Network
Preferred brand drugs $45 In-Network Tier 1; $45 In-Network Tier 2; Not Covered Out-of-Network
Non-preferred brand drugs $95 In-Network Tier 1; $95 In-Network Tier 2; Not Covered Out-of-Network
Specialty drugs 25% In-Network Tier 1; 25% In-Network Tier 2; Not Covered Out-of-Network
List of covered drugs View Covered Drugs
Three month in-network mail order pharmacy benefit Yes
Prescription drug deductible $0
Prescription drug out-of-pocket maximum Included in Combined Medical & Drug Maximum Out-of-Pocket
Access to doctors and hospitals Collapse -
Provider Directory Provider Directory
National provider network Yes
Multi-state plan No
Hospital services Collapse -
Emergency room care 10% Coinsurance after deductible In-Network Tier 1; 10% Coinsurance after deductible In-Network Tier 2; 10% Coinsurance after deductible Out-of-Network
Inpatient doctor and surgical services 10% Coinsurance after deductible In-Network Tier 1; 30% Coinsurance after deductible In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Inpatient hospital services (like a hospital stay) 10% Coinsurance after deductible In-Network Tier 1; 30% Coinsurance after deductible In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Cost and coverage examples Collapse -
Total cost for a healthy pregnancy and normal delivery Data Not Available
Total cost of managing type 2 diabetes Data Not Available
Adult dental coverage Collapse -
Routine dental care Not Covered
Basic dental care Not Covered
Major dental care Not Covered
Orthodontia Not Covered
Child dental coverage Collapse -
Check-up No Charge In-Network Tier 1; No Charge In-Network Tier 2; Not Covered Out-of-Network; 1 Visit(s) per 6 Months
Basic dental care 50% In-Network Tier 1; 50% In-Network Tier 2; Not Covered Out-of-Network
Major dental care 50% In-Network Tier 1; 50% In-Network Tier 2; Not Covered Out-of-Network
Medically necessary orthodontia Orthodontic treatment may require pre-approval and must meet the plan's 'medical necessity' criteria. 50% In-Network Tier 1; 50% In-Network Tier 2; Not Covered Out-of-Network
Medical management programs Collapse -
Asthma Asthma program available
Heart disease Heart disease program available
Depression Depression program available
Diabetes Diabetes program available
High blood pressure & high cholesterol High blood pressure & cholesterol program available
Low back pain Low back pain program available
Pain management Pain management program not available
Pregnancy Pregnancy program available
Weight loss programs Weight management program not available
Other benefits Collapse -
Acupuncture Not Covered
Chiropractic care $10 In-Network Tier 1; $20 In-Network Tier 2; 40% Coinsurance after deductible Out-of-Network; 20 Visit(s) per Year
Infertility treatment Not Covered
Mental/behavioral health outpatient services $10 In-Network Tier 1; $10 In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Mental/behavioral health inpatient services 10% Coinsurance after deductible In-Network Tier 1; 10% Coinsurance after deductible In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network
Habillitative services 10% Coinsurance after deductible In-Network Tier 1; 30% Coinsurance after deductible In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network; 30 Visit(s) per Year ; Limits and Exclusions Apply
Bariatric services Not Covered
Outpatient rehabilitative services 10% Coinsurance after deductible In-Network Tier 1; 30% Coinsurance after deductible In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network; 30 Visit(s) per Year ; Limits and Exclusions Apply
Skilled Nursing Facility care 10% Coinsurance after deductible In-Network Tier 1; 30% Coinsurance after deductible In-Network Tier 2; 60% Coinsurance after deductible Out-of-Network; 120 Days per Year
Private-duty nursing Not Covered
Thank you, rsracer.
This is a start. Did you get this info online somewhere? Can you provide a link to the full data? Phrases that catch my attention are "Tier 1," "Tier 2" and "60% Coinsurance after deductible." Rather than trouble you to defend the policy, I'd like to research it myself in detail. To do that, I need to know what those terms mean exactly and where to go to find out.
Consider this scenario. Say you are driving in a distant state (out of network) feeling healthy and well. Then, without warning, you suddenly become seriously ill. You happen to be near an emergency room and are able to park your truck at the hospital. After appendicitis is diagnosed, you are admitted for surgery to have your appendix removed.
This piece says hospitals charge anywhere from $1,529 to $182,955 for an appendectomy (insane billing practices are the norm in today's healthcare marketplace). Prices will also vary, due not to insanity but also to reality (kind of surgery needed, severity of the case, etc.)
For discussion purposes, let's say the hospital you are at charges $50,000 for the surgery (performed in the hospital, not in the emergency room) and $5,000 for the ER visit. They discharge you the next day and you get back in your truck. Doctor's orders are no strenuous activity for 30 days. Hospital security is compassionate and they let you stay in the parking lot two days to recover. Then you deadhead home, carefully and at an easy pace to fully recover there.
$60,000 hospital bill, deadhead expenses home, no revenue for 30 days.
How much of that does this policy cover? What kind of hospital bill are you left to pay?
This is a start. Did you get this info online somewhere? Can you provide a link to the full data? Phrases that catch my attention are "Tier 1," "Tier 2" and "60% Coinsurance after deductible." Rather than trouble you to defend the policy, I'd like to research it myself in detail. To do that, I need to know what those terms mean exactly and where to go to find out.
Consider this scenario. Say you are driving in a distant state (out of network) feeling healthy and well. Then, without warning, you suddenly become seriously ill. You happen to be near an emergency room and are able to park your truck at the hospital. After appendicitis is diagnosed, you are admitted for surgery to have your appendix removed.
This piece says hospitals charge anywhere from $1,529 to $182,955 for an appendectomy (insane billing practices are the norm in today's healthcare marketplace). Prices will also vary, due not to insanity but also to reality (kind of surgery needed, severity of the case, etc.)
For discussion purposes, let's say the hospital you are at charges $50,000 for the surgery (performed in the hospital, not in the emergency room) and $5,000 for the ER visit. They discharge you the next day and you get back in your truck. Doctor's orders are no strenuous activity for 30 days. Hospital security is compassionate and they let you stay in the parking lot two days to recover. Then you deadhead home, carefully and at an easy pace to fully recover there.
$60,000 hospital bill, deadhead expenses home, no revenue for 30 days.
How much of that does this policy cover? What kind of hospital bill are you left to pay?
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That is my policy. I copied/pasted from my account @ healthcare.gov
I don't believe you could view that, exactly, unless you had purchased, exactly, the coverage I purchased, with the subsidy I get. I would suggest you call Highmark @ 1.888.510.1084 or see highmarkbcbs.com. I doubt it will help you much in Florida, though.
The tiered options are a way to encourage using preferred providers, I guess. But, the cost difference is so minimal that it's a non-issue. I go to the same doctors I've always used. Blue Cross/Blue Shield accepted everywhere.
With regard to the scenario you describe, this is health insurance, not accident/sickness/disability insurance. So, I would be responsible for applicable deductible ($100.00) and out of pocket ($400.00 additional) charges, nothing more. Travel and lost wages are not paid.
You are correct about loss of income. I just threw that part in to illustrate the additional items expediters must consider when planning for health care and insurance coverage on the road. In other words, keep a healthy emergency fund.
As to the policy itself, if it is as good as you say it is, everyone should buy it. The joke made by someone above about changing states of residence to be eligible for this policy is no joke at all. You have a winner if it is as you say.
I am skeptical because our coverage is nowhere near as good and the cost is higher than anything we have paid for insurance before. I'm busy with business events for the next few days but I will definitely research this further. If you are onto something this good, I want in. A very brief search of this policy turned up a US News and World Report rating of two stars (five possible). Not sure what's behind that rating at this early point in my research.